title: Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions.
abstract: OBJECTIVE
  Trauma and infection have been postulated as "triggers" for hemorrhage from underlying brain vascular lesions (arteriovenous malformations, cavernous malformations, and aneurysms) in pediatric hemorrhagic stroke. We decided to perform an association study examining these environmental risk factors.
  
  
  METHODS
  In this case-control study nested within the cohort of 2.3 million children enrolled in a Northern California integrated health plan (1993-2004), we identified childhood hemorrhagic stroke cases through electronic searches of diagnostic and radiology databases, confirmed through chart review. Three age- and facility-matched controls per case were randomly selected from the study population. Exposure variables were measured using medical records documented before stroke diagnosis. Main outcome measure was hemorrhagic stroke.
  
  
  RESULTS
  Of 132 childhood, non-neonatal hemorrhagic stroke cases, 65 had underlying vascular lesions: 34 arteriovenous malformations, 16 cavernous malformations, and 15 aneurysms. A documented exposure to head and neck trauma in the prior 12 weeks was present in 3 cases (4.6%) with underlying vascular lesions, compared with no controls (p < 0.015). However, all 3 vascular lesions were aneurysms, and traumatic pseudoaneurysms were possible. Recent minor infection (prior 4 weeks) was present in 5 cases (7.7%) and 9 controls (4.6%) (p = 0.34).
  
  
  CONCLUSIONS
  Our observed association between trauma and hemorrhagic stroke with a vascular lesion may be explained by traumatic pseudoaneurysms. Neither recent head or neck trauma nor infection appeared to be a "trigger" for pediatric hemorrhagic stroke due to underlying vascular malformations.
authors.affiliation: Department of Neurology, University of California, San Francisco, USA.
authors.forename: Nilika Shah
authors.initials: NS
authors.lastname: Singhal
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Hills
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology*; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D054079:Vascular Malformations / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult